Acute Agitation

Question 1

Agitation associated with DELIRIUM

ETOH or BZN withdrawal not suspected

Answer 1

Identify and correct any underlying medical condition

AVOID BENZODIAZEPINE

1. Oral 2nd-generation Antipsychotics
   risperidone 2 mg
   olanzapine 5–10 mg
2. Oral 1st-generation Antipsychotics
   haloperidol (low dose)
3. Parenteral 2nd-generation Antipsychotics
   olanzapine 10 mg IM ziprasidone 10–20 mg IM
4. Parenteral 1st-generation Antipsychotics
   haloperidol (low dose)§ IM or IV (with caution)†
   § There is strong evidence that doses > 3 mg/day in patients with delirium are associated with
   significant risk of EPS,46 so patients
   receiving > 3 mg/day should be
   assessed carefully for EPS.

Question 2

Agitation associated with DELIRIUM

ETOH or BZN WITHDRAWAL

Answer 2

1. Oral Benzodiazepines
   lorazepam 1–2 mg
   chlordiazepoxide 50 mg
   diazepam 5–10 mg
2. Parenteral Benzodiazepines
   lorazepam 1–2 mg IM or IV

Question 3

Agitation due to Intoxication

CNS Stimulant

Answer 3

1. Oral Benzodiazepines
   lorazepam 1–2 mg
   chlordiazepoxide 50 mg
   diazepam 5–10 mg
2. Parenteral Benzodiazepines
   lorazepam 1–2 mg IM or IV

Question 4

Agitation due to Intoxication

CNS Depressant (e.g., ETOH)

Answer 4

AVOID BENZODIAZEPINE if possible

1. Oral 1st-generation
   Antipsychotics
   haloperidol 2–10 mg
2. Parenteral 1st-generation
   Antipsychotics
   haloperidol 2–10 mg IM

Question 5

Agitation associated with psychosis in patient with
known psychiatric disorder

Answer 5

1. Oral 2nd-generation Antipsychotics
   risperidone 2 mg‡
   olanzapine 5–10 mg‡
2. Oral 1st-generation Antipsychotics
   haloperidol 2–10 mg with BZN
3. Parenteral 2nd-generation Antipsychotics
   olanzapine 10 mg IM‡
   ziprasidone 10–20 mg IM‡
4. Parenteral 1st-generation Antipsychotics
   haloperidol 2–10 mg IM with
   BZN
   ‡If an antipsychotic alone does not work sufficiently,
   add lorazepam 1–2 mg (oral or parenteral).

Question 6

Undifferentiated agitation or complex presentation

Answer 6

No Psychosis Evident
Same as agitation due to withdrawal

1. Oral Benzodiazepines
   lorazepam 1–2 mg
   chlordiazepoxide 50 mg
   diazepam 5–10 mg
2. Parenteral
   Benzodiazepines
   lorazepam 1–2 mg IM or IV

Psychosis Evident
Same as for primary psychiatric disorder

1. Oral 2nd-generation Antipsychotics
   risperidone 2 mg‡
   olanzapine 5–10 mg‡
2. Oral 1st-generation Antipsychotics
   haloperidol 2–10 mg with
   BZN
3. Parenteral 2nd-generation Antipsychotics
   olanzapine 10 mg IM‡
   ziprasidone 10–20 mg IM‡
4. Parenteral 1st-generation Antipsychotics
   haloperidol 2–10 mg IM with
   BZN